Local oestrogen therapy: how it differs from conventional HRT

 

Why might you need local oestrogen therapy?

 

·         At least 50% of women who have been through the menopause suffer from symptoms resulting from changes to their vagina and genital area

·         These include:

 

o   Vaginal dryness, soreness, itching or burning

o   Vaginal discharge or light spotting of blood

o   Discomfort and pain during sex

o   Urinary symptoms, such as having to rush to go to the toilet, going frequently or getting up at night more often

o   Recurrent urinary tract infections (UTIs)

o   Rubbing, discharge or discomfort when using pessaries to treat a prolapse

 

Why does this happen?

 

·         The female hormone oestrogen, produced by the ovaries, is important in keeping the tissues in and around the vaginal area healthy, supple and moist. It helps the lining of the vagina remain thick and elastic whilst maintaining the right environment to fight infection

·         After the menopause, the ovaries stop producing oestrogen so the amount of hormone in a woman’s body decreases

·         This can lead to the tissues in this area becoming thin, dry, less elastic and generally more delicate

·         The vagina & bladder may also be more prone to infection after the menopause

·         The combination of these changes is sometimes called vaginal atrophy or atrophic vaginitis

 

By replacing the oestrogen directly to the vagina, it is possible to reverse some of these changes by restoring the tissues in this area

 

Are there different types of local oestrogen therapy?

 

·         Yes!

·         The most popular type is a slow-release vaginal tablet. This is commonly known as Vagifem. It is a low dose natural oestrogen, which is easy and hygienic to use. One pea-sized tablet is inserted into the vagina using a small disposable applicator. This is usually given every day for the first 2 weeks, and then twice a week for about 3 months

·         Vaginal oestrogen creams, such as Gynest, are another way of delivering oestrogen directly to the tissues that need it but some people find it a little more ‘messy’

·         All types of local oestrogen therapy are equally effective for treating your symptoms

 

How long does it take to work?

 

·         Most women find that their symptoms start to improve within 2 weeks but to get the full effect takes a couple of months, so persevere!

 

What is Hormone Replacement Therapy (HRT)? Aren’t there risks associated with taking HRT, such as breast cancer?

 

·         HRT is a way of replacing oestrogen, and another hormone called progesterone, once the ovaries stop producing them

·         HRT is commonly given as oral tablets or patches on the skin

·         It is usually given to reduce menopausal symptoms such as hot flushes and vaginal atrophy as well as protecting women against bone thinning

·         There is some evidence that taking HRT for a long time gives women a small increased risk of blood clots in the legs and developing cancer, such as breast cancer

 

How is local oestrogen therapy different?

 

·         Local therapy supplies oestrogen to the vagina and surrounding areas without giving it to the whole body

·         It is delivered directly to the tissues that need it, so lower doses are needed

·         Only a very small amount is absorbed into the blood stream and so has less of an effect on the rest of the body. This decreases the risks associated with hormone treatment to almost zero

·         Local oestrogen therapy has a similar effect on vaginal and urinary symptoms as systemic (oral) oestrogen therapy but will not help hot flushes, mood swings, night sweats etc.

 

Because a very small amount of oestrogen is absorbed into the blood stream, manufacturers have traditionally said on the data sheets that local oestrogen therapies carry the same risks as other forms of HRT and so carry the same warnings. There is however no evidence to support this, and for newer preparations, such as Vagifem, the information leaflets are less prescriptive.

 

How long can I use it for?

 

·         In the UK, vaginal creams are licensed for 3-6 months of continuous use. For Vagifem, this has now been extended to indefinitely at the recommended dose.

 

What are the side effects of local oestrogen therapy?

 

·         Small amounts of hormone in the blood stream may cause oestrogen-related side effects such as breast tenderness

·         Some women experience irritation around the vagina

 

Who should avoid using oestrogen tablets or creams?

 

·         Women who currently have oestrogen-dependent cancers, such as breast or uterine cancer

·         Women with a past history of breast cancer, angina or blood clots in the legs should seek

 

specialist advice

·         Women who are having investigations for post-menopausal bleeding (bleeding from the vagina after having stopped periods) should delay using them until a cause has been found. Local oestrogen may however be a treatment for this in many cases.

 

Glossary

Oestrogen – a female hormone, produced by the ovaries

Progesterone – another female hormone produced by the ovaries, which is not contained in local oestrogen therapy

Menopause – commonly known as ‘the change’. This is when the ovaries stop producing hormones, such as oestrogen. It happens at around age 50 and is associated with symptoms such as hot flushes and vaginal dryness and soreness

HRT – Hormone Replacement Therapy. This is a way of giving oestrogen and progesterone to the whole body to reduce the symptoms associated with the menopause